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Menopause And HRT Made Easy PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Menopause and HRT- made easy” by Anita Juliana MBBS, MD, FRCOG.

This medical PowerPoint presentation is about menopause and hormone replacement therapy.

Menopause is a natural biological process that marks the end of a womans reproductive years. It is defined as the time when a woman has not had a menstrual period for 12 consecutive months. Menopause is a normal and expected part of aging for women, usually occurring between the ages of 45 and 55.

Hormone replacement therapy (HRT) is a treatment option that may be recommended for women who are experiencing symptoms related to menopause, such as hot flashes, night sweats, vaginal dryness, and mood changes. HRT involves the use of hormones (usually estrogen and progesterone) to supplement the bodys natural hormone levels.

HRT can be administered in various forms, including pills, patches, creams, gels, and vaginal rings. The type of HRT and the way it is administered will depend on individual circumstances, such as a womans medical history, age, and symptoms.

HRT has been shown to be effective in relieving menopausal symptoms, but it also carries some risks. Long-term use of HRT may increase the risk of breast cancer, stroke, blood clots, and heart disease. As a result, HRT should be used at the lowest effective dose for the shortest duration necessary to control symptoms.

It is important for women to discuss the potential benefits and risks of HRT with their healthcare provider to determine if it is a safe and appropriate treatment option for their individual needs. Women who have had certain types of cancer or have a history of blood clots or heart disease may not be good candidates for HRT.

Tags : menopause, hormone replacement therapy (HRT), permanent cessation of menstruation, perimenopause, Obstetrics and Gynecology, Obstetrics and Gynecology PowerPoint presentation

Published on : Jun 20, 2023 | Views : 1123 | Downloads : 9

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Slide 1-

Menopause and HRT- made easyAnita Juliana MBBS, MD, FRCOGConsultant Obstetrician and GynaecologistMenopause Lead for NUH
Slide 2-

‘They thought I was a hypochondriac. It’s taken me years to convince them that there was something else besides neurosis’ ‘I didn’t feel like a ‘real woman’. I felt inferior’ ‘I felt like a new person. I was reborn, even though they were brought on by tablets’ ‘Most people say; ‘At my age’, ‘I’m at the age’ and I think, ‘well, I’m not, not at all, I’m half the age’……………… Setting the scene
Slide 3-

Objectives Refresh and strengthen the basics Clarify myths NICE Update Case discussions
Slide 4-

Menopause- Basics What is Menopause? Symptoms Treatment – Yes or No Myths around HRT
Slide 5-

What is Menopause? Meno - pause ( Cessation of periods) 12 months after last Menstrual period Average age in UK is 51 years Peri Menopause – Irregular periods +Symptoms (45-55 age range) Premature Menopause – Below 40 years (1% of women) Early Menopause is below 45 years (Around 5%-20%)
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Menopause – Why ? Fixed number of eggs when a girl baby is born. 2,000,000 oocytes at birth 25000 at 37 years 1000 oocytes at the age of 50 Rate of decline is variable
Slide 8-

Menopause - Process
Slide 9-

Menopause
Slide 10-

Premature menopause Aetiology - Various Elevated FSH levels > 30 IU/L (two samples 4-6 weeks apart) Fertility issues Osteoporosis - Increased risk Need HRT until 51 years Refer for expert opinion
Slide 11-

Primary care challenges One third of women's life is post menopause Post cancer survivors Quality is priority Risks versus Benefits Role of Media Time limit Too many visits....
Slide 12-

Yes You Can Prescribe HRT in 45+ year old women Symptoms obvious No contraindications Initial investigations Premature Menopause
Slide 13-

Primary care Dilemmas Premature / Early menopause Not so obvious peri -menopause Post cancer, post surgical menopause Older women Unsettled with HRT Contraindication for HRT Increased risks Media wise customers ( Bio-identicals, Natural hormones)
Slide 14-

Menopause-How does it affect? Not everybody suffers with symptoms 70% - Vasomotor symptoms (Hot flushes, sweats) Varies – familial , Ethnicity Duration – 6 months – 20 years (Average 7.4 years) Crucial time (45 -55 years) After 60, requirement for estrogen reduced
Slide 15-

What to do? Awareness Coping mechanisms (Diet, lifestyle, Exercises) If severe, consider HRT
Slide 16-

Diet, Exercise, Lifestyle Diet – Healthy eating ( Fruit, Veg, Dairy, Fish, Low fat, high fibre) Managing Optimal weight and BMI ( Reduces risk of CHD, Type 2 diabetes, Osteoporotic Fracture) Exercise (Weight bearing, Fast walking, Tai chi, Pilates ) Helps to reduce risk of heart disease, osteoporotic fractures by increasing bone mineral density Stop smoking Limited alcohol
Slide 17-

Hormone Replacement Therapy - HRT Estrogen (Main), Progestogens (Endometrial protection) and Testosterone (Rarely used) Truly effective to reduce symptoms and long term benefits for bones Variable preparations More than 50 different types, doses, routes)
Slide 18-

HRT - Continued Women with uterus Estrogen and Progesterone Still having periods or within 1 year of LMP Cyclical/Sequential More than one year of LMP or after 54 years Continuous Combined After 1 year of Cyclical Change to Continuous Combined Women without uterus Estrogen only
Slide 19-

HRT - Continued Estrogen preparations Ethinyl estradiol Conjugated estrogen Estradiol Estriol Estrone Progestogen preparations Norethisterone Levonorgesterol Dydrogestrone MPA Mirena IUS Micronised Progesterone – Utrogesterone ( Natural)
Slide 20-

Doses & routes Oral 0.5mg, 1mg, 2mg (once a day) Patches 25, 37.5, 50, 75, 100 mcg (twice weekly) – below waist Gel/Pessary/Cream Progestogens - variable Mirena (20mcg LNG/day) Natural progestogen (utrogestan) 100 or 200mcg Testosterone (gel, cream) Implants no longer available in UK
Slide 21-

HRT – Side effects Headaches Breast tenderness Fluid retention Bloating Nausea Mood swings
Slide 22-

HRT – Contraindications Very few category of women Estrogen dependant malignant tumor ( Breast, Endometrial) Undiagnosed vaginal bleeding Current DVT/PE Pregnancy
Slide 23-

HRT - Concerns Myths Increases Breast cancer risk Increases Coronary heart disease Published by Media widely in 2003 Is this true?
Slide 24-

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HRT – Risks Two studies in early 2000 Women's Health Initiative (WHI) Million Women study (MWS)
Slide 26-

HRT – Risks Women's Health Initiative (WHI) USA (1993-2002) 16600 women (50-79) Average age 63.2, BMI 28.5 Randomised HRT Vs Placebo Increase in Breast cancer and coronary events, stroke, DVT in HRT group Study stopped early in 2002 HRT in under 60 – Protective In over 70, not beneficial could be increased risk Risk is duration dependant, more risk with combined than for estrogen only. Million Women study (MWS) UK (1996-2003) One million women attending NHS Breast screening clinic over 50 years old Questionnaire sent out Large number of drop outs Screening women are already high risk Study methodology has been criticised Oestrogen only increases risk of breast, womb and ovarian cancer Combined more risk than estrogen only
Slide 27-

HRT – Risks ( Latest analysis) Breast cancer risk – 4 extra cases /1000 women after 5 years (This is less risk than smoking 10 cigs/day) 45/1000 – population risk 49/1000 – HRT (5 years) 51/1000 – HRT (10 years) Ovarian cancer – No increased risk Endometrial cancer – Adding progestogen decreases risk
Slide 28-

HRT – Risks ( Latest analysis) Risk of heart disease not increased if started between 50 and 59 Stroke – not increased if started under 60. More risk with Smoke and Over weight Weight gain – RCT no evidence Osteoporosis – Useful more in Premature menopause, but not a first line for prevention in older Do not use HRT In Breast or Endometrial cancer, Stroke or DVT, Severe liver disease.
Slide 29-

Alternative options Tibolone (Livial) – oestrogenic, progestogenic & androgenic properties SERM - Raloxifene SSRI/SNRI - Venlafaxine/Fluoxetine/Paroxetine Clonidine - not very effective Complementary - soya, red clover, black cohosh, evening primrose, acupuncture, homeotherap Insufficient data for safety & effectiveness Non –Pharmacological - CBT
Slide 30-

Bio-identical Hormones Identical to those produced by body 17 – beta estradiol or Micronized progesterone Claimed to be safe than traditional hormones Same risk and benefit as traditional Not regulated Not enough evidence for safety Salivary hormones – not representative of serum levels
Slide 31-

NICE Menopause – Diagnosis and Management Nov 2015
Slide 32-

Diagnosis of perimenopause and menopause Challenge is to reduce the use of FSH in diagnosing perimenopause and menopause No periods for at least 12 months & not using hormonal contraception = menopause Women without uterus but has menopausal symptoms = menopause DO NOT use FSH test to diagnose menopause if on COCP or high dose progestogen Consider using FSH test as a diagnostic test for menopause: Age 40-45 years with menopausal symptoms including irregular periods < age 40 with a suspicion of early onset of menopause
Slide 33-

Diagnosis of perimenopause and menopause DO NOT use the following test to diagnose menopause > 45 years old Inhibin A and inhibin B Estradiol Anti-Mullerian hormone Antral follicle Ovarian volume
Slide 34-

Vaginal oestrogens Can be used in HRT contraindicated women after expert advice Increase dose if needed after expert advice (Up to 5 times a week) Used along with vaginal lubricants and moisturisers
Slide 35-

Altered sexual function HRT If HRT alone not effective, consider testosterone supplementation In younger women where ovaries are absent, testosterone is considered.
Slide 36-

HRT and Contraception Age 40 Women using HRT should not rely on this as contraception POP can be used with HRT to provide effective contraception (must be combine HRT) Can use oestrogen replacement therapy + MIRENA to provide endometrial protection
Slide 37-

Women with, or at high risk of breast cancer Give information on all treatment options Paroxetine and Fluoxetine should not be offered to patients with breast cancer on tamoxifen Refer for expert advice
Slide 38-

Stopping HRT Advice regarding stopping HRT 2 choices – gradually reducing or immediate cessation Gradually reducing HRT may reduce the recurrence of symptoms in the short term No difference of symptoms in long term
Slide 39-

Case discussion
Slide 40-

Case study 52 year old secondary school teacher No relevant medical history Always calm and organised Recently irritable and struggling to cope with minor challenges Exploited by school children of her weakness Unable to sleep, asking GP for more sleeping tablets
Slide 41-

How to approach? Relevant history LMP 6/12 ago, before that 3/12 ago Night sweats with severe chills sometimes, occasional day time flushes Often wakes then sweats No interest in sex, often it hurts
Slide 42-

What to do next? Explanation Information www.menopausematters.co.uk www.womens-health-concern.org.uk www.menopause-health-concern.org.uk www.daisynetwork.org.uk
Slide 43-

What do we choose now? Sequential combined HRT Elleste duet 1mg Estradiol 1mg plus NET 1mg from day 17-28 NHS cost £9.72 for 3 months
Slide 44-

Review in 3 months Persistence of symptoms Any new symptoms/side effects? When do they occur in the cycle? Bleeding pattern BP Review of risk analysis
Slide 45-

3 months later Symptoms and sleep better in the first 2 weeks of the pack Not so good and tearful when pill colour changes Bleeding is fine 2- 3 days in to the new pack Would like to improve things
Slide 46-

Modify treatment Increase estrogen Change progestogen preparation Femoston 2:10 ( 17B estradiol 2mg plus 10mg dydrogesterone) Cost £13.47 for 3 months
Slide 47-

HRT- Dilemmas More Case Discussions
Slide 48-

Case 1 33 year old, Aplastic anemia ( when she was 25), had chemo, No periods for many years. Now, random periods, terrible menopausal symptoms
Slide 49-

Case 1 - Discussion Possible Premature Ovarian Insufficiency Confirm with FSH Combined, sequential HRT until 51.
Slide 50-

Case 2 52 years old, post Lap BSO for BRAC2. On Tamoxifen for Chemo prevention of breast Cancer Low mood, tiredness, night sweats, Vaginal dryness, No sex drive Type 1 diabetic, high BMI, High BP
Slide 51-

Case 2 - Discussion Clarify Tamoxifen HRT? If so what type?
Slide 52-

Case 3 59 year old, police officer, been on HRT for 7 years. Trying to come off it. GP advised to stop. Severe symptoms. Back on it. Better now. Advised to come off it gradually. How?
Slide 53-

Case 3 - Discussion How to stop HRT? Doses Choices
Slide 54-

Case 4 For patients with endometriosis who had a TAH BSO Choice of HRT 36 year old, Had TAH+BSO, 2 years ago, HRT stopped after caution from pelvic pain. Want are the options?
Slide 55-

Menopause clinic at NUH Service offered by Anita Juliana MBBS,MD, FRCOG Special interest in Menopause RCOG Accredited Started service at NUH from June 2015 Weekly clinic with Senior nurse support
Slide 56-

What's on offer? Individually tailored advice, care and support 30 minutes minimum, sometimes longer Careful risk assessment Necessary investigations ( DEXA Scan, blood tests and scans when needed ) Life style advice, information leaflets/web info Clear plan of management and communication
Slide 57-

Referrals Choose and Book Oncologists Gynaecologists Breast cancer service Family history clinics
Slide 58-

Outside Menopause clinic NUH - Staff awareness sessions on Menopause - Run quarterly, alternates both sites Tea party talks for BRCA positive patients Both are very well received and popular with high demand
Slide 59-

We are partners in Women's health Think of Menopause service at NUH Safe, Reliable, Gold standard care
Slide 60-

Feedback from our patients Finally, somebody listened to me Got my life back Excellent service All questions answered Put my mind at rest Very happy.... Took a long time to reach here....
Slide 61-

Questions?
Slide 62-

Thank you